Provider Demographics
NPI:1700399649
Name:KOTILA, JOAN MARIE (APRN CNP)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARIE
Last Name:KOTILA
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Gender:F
Credentials:APRN CNP
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Mailing Address - Street 1:CENTRACARE CLINIC ST CLOUD MEDICAL GROUP NORTHWEST
Mailing Address - Street 2:251 COUNTY ROAD 120
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4872
Mailing Address - Country:US
Mailing Address - Phone:320-202-8949
Mailing Address - Fax:320-257-1733
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4872
Practice Address - Country:US
Practice Address - Phone:320-202-8949
Practice Address - Fax:320-257-1733
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
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Provider Licenses
StateLicense IDTaxonomies
MN2019769163W00000X
MN5273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse